CPT 20100
Global 010 ActiveExpl pentrg wound neck
CPT 20100 Billing & Documentation Guide
CPT code 20100 (Expl pentrg wound neck) is classified under Surgery (Musculoskeletal) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 10.12, a non-facility practice expense RVU of 4, and a malpractice RVU of 2.22, a total non-facility RVU of 16.34 and facility RVU of 16.34. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $547.83, though rates vary from $488.85 to $690.17 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20100, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 20100 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 20100 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 20100
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.12 | 10.12 |
| Practice Expense RVU | 4 | 4 |
| Malpractice RVU | 2.22 | 2.22 |
| Total RVU | 16.34 | 16.34 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20100
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $548.43 | $548.43 | $529.94 - $607.6 | 29 |
| Florida | $616.41 | $616.41 | $577.19 - $664.62 | 3 |
| Georgia | $554.71 | $554.71 | $545.58 - $563.83 | 2 |
| Illinois | $610 | $610 | $575.89 - $644.83 | 4 |
| Michigan | $567.84 | $567.84 | $543.71 - $591.96 | 2 |
| North Carolina | $510.05 | $510.05 | $510.05 - $510.05 | 1 |
| New York | $603.9 | $603.9 | $517.07 - $656.2 | 5 |
| Ohio | $534.74 | $534.74 | $534.74 - $534.74 | 1 |
| Pennsylvania | $551.19 | $551.19 | $530.74 - $571.64 | 2 |
| Texas | $540.29 | $540.29 | $528.48 - $575.42 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 20100
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20100 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 20100
What does CPT code 20100 mean? +
CPT code 20100 represents: Expl pentrg wound neck. It's in the Surgery (Musculoskeletal) category with a global period of 010.
What is the Medicare reimbursement for CPT 20100? +
The 2026 Medicare national average non-facility payment for CPT 20100 is $547.83. Rates range from $488.85 to $690.17 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20100? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 20100? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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